Evolución y tratamiento de los trastornos de la conducta alimentaria en adolescentes: serie de casos / Treatment of eating disorders in adolescents: case series

Los trastornos de la conducta alimentaria son enfermedades de elevada prevalencia en la adolescencia y tienen repercusión en la salud integral. El objetivo fue describir su evolución y tratamiento en un grupo de adolescentes. Se estudiaron adolescentes menores de 18 años con al menos 6 meses de seguimiento y tratados por un equipo interdisciplinario. Se incluyeron 41 adolescentes: 23 presentaron anorexia nerviosa; 9, trastornos alimentarios no especificados; 7, bulimia nerviosa y 2, trastorno por atracones. El 35 % de pacientes con anorexia nerviosa requirió internación por complicaciones de la desnutrición. El 69 % de las pacientes con anorexia nerviosa, el 57 % de quienes tenían bulimia nerviosa y el 78 % de quienes tenían un trastorno alimentario no especificado presentaron remisión total o parcial, y no hubo pacientes fallecidos. La mayoría presentó una evolución favorable con el tratamiento.

Eating disorders are highly prevalent diseases in adolescence and have an impact on overall health. The objective was to describe the evolution and treatment of eating disorders in adolescents. Adolescents under 18 years of age with at least 6 months of follow-up and treated by an interdisciplinary team were studied. Forty one adolescents were included, 23 presented anorexia nervosa, 9 unspecified eating disorders, 7 bulimia nervosa and 2 binge eating disorders. Thirty five percent of patients with anorexia nervosa required hospitalization for complications of malnutrition. Sixty nine percent of the patients with anorexia nervosa, 57 % with bulimia nervosa, and 78 % with unspecified eating disorders had total or partial remission and there were no deceased patients. The majority presented a favorable evolution with the treatment.

Risk factors for eating disorders: an umbrella review of published meta-analyses

Objective: To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. Methods: This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. Results: Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. Conclusions: The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

Risk of anorexia and bulimia nervosa and its associated factors in undergraduate students / Risco de anorexia e bulimia nervosa e seus fatores associados em estudantes de graduação

ABSTRACT Objective To quantify the prevalence and related factors to the risk of anorexia and bulimia nervosa in undergraduate students at a private university in Bogotá, Colombia. Methods A cross-sectional study, which evaluated the frequency of food consumption, physical activity (International Physical Activity Questionnaire, short form), the risk of anorexia and bulimia nervosa (Sick, Control, One, Fat, and Food questionnaire) and demographic variables. The statistical analysis used a multivariate logistic regression model, where the outcome was the yes/no risk of anorexia or bulimia nervosa. Results A total of 1,545 university students participated. The average age was 19.2 years (+/-2.5), 65.7% were women, and 63.9% came from Bogotá. The risk of anorexia and bulimia nervosa was 27.6%. In the logistic regression, the risk was associated with female sex (OR 1.6 CI95% 1.2 to 2.1), daily consumption of cereals (OR 0.7 CI95% 0.6 to 0.9), daily fat consumption (OR 1.5 CI95% 1.1 to 2.1), eat light products (OR 1.8 CI95% 1.1 to 2.9), consume protein supplements (OR 0.4 CI95% 0.2 to 0.8), being in disagreement with physical activity for fun (OR 1.8 CI95% 1.1 to 3.1), and physical activity by appearance (OR 2.2 CI95% 1.6 to 2.9). Conclusions The prevalence of risk to anorexia and bulimia nervosa in the study sample is high. The associated factors were the consumption of cereals, fat, light products, and protein supplements. Physical activity by appearance and disagreement to do exercise by fun were associated with the risk of anorexia and bulimia nervosa. So it is recommended that universities implement awareness and education interventions to address this problem.

RESUMO Objetivo Quantificar a prevalência e os fatores relacionados ao risco de anorexia e bulimia nervosa em estudantes de graduação de uma universidade particular de Bogotá, Colômbia. Métodos Estudo transversal, que avaliou a frequência de consumo alimentar, atividade física (ferramenta (Questionário Internacional de Atividade Física, versão curta), risco de anorexia e bulimia nervosa (Questionário de doença, controle, um, gordura e comida) e variáveis demográficas. A análise estatística utilizou um modelo de regressão logística multivariada, em que o resultado foi o risco sim / não de anorexia ou bulimia nervosa. Resultados Participaram 1.545 estudantes universitários. A idade média era de 19,2 anos (+/- 2,5), 65,7% eram mulheres e 63,9% eram de Bogotá. O risco de anorexia e bulimia nervosa foi de 27,6%. Na regressão logística, o risco foi associado ao sexo feminino (OR 1,6 IC95% 1,2 a 2,1), consumo diário de cereais (OR 0,7 IC95% 0,6 a 0,9), consumo diário de gordura (OR 1,5 IC95% 1,1 a 2,1), comer produtos leves (OR 1,8 IC95% 1,1 a 2,9), consomem suplementos proteicos (OR 0,4 IC95% 0,2 a 0,8), discordam de atividade física para se divertir (OR 1,8 IC95% 1,1 a 3,1) e atividade física pela aparência (OR 2,2 CI95% 1,6 a 2,9). Conclusão A prevalência de risco para anorexia e bulimia nervosa na amostra do estudo é alta. Os fatores associados foram o consumo de cereais, gorduras, produtos light e suplementos proteicos. A atividade física pela aparência e a discordância para fazer exercício pela diversão estiveram associadas ao risco de anorexia e bulimia nervosa. Portanto, é recomendado que as universidades implementem intervenções de conscientização e educação para resolver esse problema.

Eating disorders and psychosis: a review and case report

SUMMARY INTRODUCTION: The interplay between eating disorders and psychosis is a challenging field to which little attention has been paid. Its study raises conceptual and methodological questions in both areas, making the diagnosis and management of patients difficult. Such questions are addressed and illustrated with a review and case report. METHODS: The authors present the case of a woman with Anorexia Nervosa and with comorbid Shared Psychotic Disorder, based on a literature review regarding the comorbidity between eating disorders and psychosis. The authors conducted a non-systematic review by searching the PubMed database, using the Mesh Terms "anorexia nervosa", "bulimia nervosa", "comorbidity" and "psychotic disorders". RESULTS: The findings suggest that studies on the subject are limited by issues regarding data on the prevalence of comorbidities, phenomenological aspects of eating disorders, and the interface and integration with psychotic symptoms. CONCLUSIONS: The case presented illustrates the difficulties in managing a patient with a comorbid eating disorder and psychosis. In order to ensure a rigorous assessment of both psychotic and eating disorder symptoms, the focus should be on the pattern of appearance or emergence of symptoms, their phenomenology, clinical and family background of the patient, and clinical status on follow-up.

RESUMO INTRODUÇÃO: A interface entre perturbação do comportamento alimentar e psicose é um campo desafiador para o qual pouca atenção foi direcionada. O seu estudo levanta algumas questões conceituais e metodológicas em ambas as áreas, dificultando o diagnóstico e o manejo dos pacientes. Essas questões são abordadas e ilustradas neste trabalho com uma revisão e um relato de caso. MÉTODOS: Os autores apresentam o caso de uma mulher com anorexia nervosa e perturbação psicótica partilhada comórbida, com base numa revisão da literatura sobre a comorbilidade entre perturbação do comportamento alimentar e psicose. Os autores realizaram uma revisão não sistemática, por meio de pesquisa no banco de dados PubMed, utilizando os termos "anorexia nervosa", "bulimia nervosa", "comorbilidade" e "perturbações psicóticas". RESULTADOS: Os resultados sugerem que os estudos sobre o tema são limitados por questões inerentes a escassos dados sobre prevalência de comorbilidades, aspectos fenomenológicos das perturbações alimentares, e sua interface e integração com sintomas psicóticos. CONCLUSÕES: O caso apresentado ilustra as dificuldades no manejo de uma paciente com perturbação alimentar e psicose. A fim de garantir uma abordagem rigorosa dos sintomas psicóticos e alimentares, a avaliação do paciente deve focar o padrão de emergência dos sintomas, a sua fenomenologia, antecedentes clínicos e familiares e o seu status clínico.

Anorexia nerviosa en población pediátrica / Anorexia nervosa in pediatrics

Resumen La anorexia nerviosa se caracteriza por una sobreestimación del volumen y forma del cuerpo, que conlleva a una búsqueda de la delgadez mediante dietas rígidas. Esta se presenta en 0.6% de la población mundial, siendo las mujeres adolescentes quienes más la padecen y ocurriendo en pacientes cada vez más jóvenes. Con respecto a los criterios diagnósticos, actualmente no se cuenta con rubros o guías específicas para la población pediátrica, lo que dificulta su valoración. En cuanto al tratamiento, se recomienda la realimentación progresiva alcanzar el peso esperado para el sexo y edad del paciente, en conjunto con terapia psicológica individual y familiar. Se concluye que es fundamental para el abordaje de la anorexia nerviosa ampliar la investigación para asegurar que las particularidades de esta en la población pediátrica, en su diagnóstico, tratamiento y prevención, sean contempladas. Asimismo, se insiste en la necesidad del trabajo interdisciplinario para lograr una recuperación integral.

Abstract Anorexia nervosa is a disorder characterized by an overestimation of the volume and shape of the body, which leads them to seek excessive thinness through rigid diets. It occurs in 0.6% of the world population, mostly affecting teenage girls and increasingly occurring in young patients. Nowadays, there are no specific guidelines for anorexia nervosa in pediatric patients which complicates its assessment. The recommended treatment is progressive feeding until the patient gains the expected weight for the patient, according to his sex and age, alongside individual and family therapy. It is concluded that further research is key to assure that the particularities of diagnosis, treatment and prevention of the disorder in pediatric patients are contemplated. Likewise, interdisciplinary work is necessary to achieve an integral approach.

Pain and temporomandibular disorders in patients with eating disorders

Abstract Orofacial pain and temporomandibular dysfunction may cause chronic facial pain, which may interfere with the emotional state and food intake of patients with eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN). Sixty-four patients were assigned to four groups: Group A (AN - restricting subtype): 07; Group B (AN - purging subtype ): 19; Group C (BN): 16; and Group D (control): 22. Complaints of pain are more prevalent in individuals with eating disorders (p<0.004). There are differences between the presence of myofascial pain and the number of hospitalizations (p = 0.046) and the presence of sore throat (p=0.05). There was a higher prevalence of masticatory myofascial pain and complaints of pain in other parts of the body in ED patients; however, there was no difference between ED subgroups. There was no difference in the number of self-induced vomiting between ED patients with and without myofascial pain.

Trastornos de la conducta alimentaria en estudiantes de medicina de una universidad de Perú / Eating disorders in medical students of a Peruvian university

Introducción: Los trastornos de la conducta alimentaria afectan con mayor frecuencia a jóvenes, y pueden llegar a tener importantes consecuencias en su salud mental y física. Objetivo: Determinar la prevalencia de probable diagnóstico de trastornos de conducta alimentaria en estudiantes de medicina y sus factores asociados. Métodos: Estudio descriptivo transversal realizado en estudiantes de medicina del primer año de una universidad de Lima, Perú. Se aplicó un cuestionario virtual para recolectar los datos de interés. Aquellos con un puntaje ≥20 en elEatingAttitudes Test-26, se consideronconprobable diagnóstico de trastornos de conducta alimentaria.Para evaluar los factores se calcularon razones de prevalencia y intervalos de confianza al 95% usando regresiones de Poissoncrudas con varianza robusta. Resultados: Del total de 440 estudiantes de primer año, 375 (85,2 por ciento) completaron la encuesta. La prevalencia de probable diagnóstico de trastornos de conducta alimentaria fue de 10,1 por ciento (11,3 en mujeres y 8,6 en varones).Los factores asociados a esta variable fueron: rechazo escolar por trastornos nutricionales, rechazo laboral por la delgadez, rechazo social cercano por la imagen corporal, influencia familiar sobre la imagen corporal, influencia de la imagen corporal de modelos de pasarela e influencia de los anuncios televisivos de productos para adelgazar. Los dos últimos con los mayores valores de la razón de prevalencias. Conclusiones: Aproximadamente uno de cada diez estudiantes presentaprobable diagnóstico de trastornos de conducta alimentaria que se asocian con factores familiares, sociales,laborales y otros relacionados con los medios de comunicación(AU)

Introduction: Eating disorders affect mostly young persons, and may have important consequences on their mental and physical health. Objectives: To determine the probable diagnosis of eating disorders in medical students and to evaluate their associated factors. Methods: Descriptive and cross-sectional study performed in first-year medical students of a private university in Lima, Peru. An electronic survey was administrated to collect data of interest. Those students with a score ≥20 in the Eating Attitudes Test-26 were considered to have probable diagnosis of eating disorders. For assessment of associated factors, we calculated prevalence ratios and 95 percent confidence intervals using Poisson crude regressions with robust variance. Results: Of 440 first-year medical students, 375 (85.2 percent) completed our survey. The prevalence of probable diagnosis of eating disorders in the study population was 10.1 percent (11.3for females and 8.6for males). Associated factors to this variable were: school rejection due to nutritional disorders, job rejection due to thinness, social rejection of body image, family influence on body image, influence of fashion show models' body image and influence of TV advertisement of slimming products. The two latter reached the highest prevalence ratio values. Conclusions: Around one in ten students has a probable diagnosis of eating disorders associated with family, social, work and mass media-related factors(AU)

Transtornos alimentares na infância e na adolescência / Eating disorders in childhood and adolescence / Trastornos alimentares en la infancia y adolescencia y factores de riesgo

OBJETIVO: Discutir os transtornos alimentares em crianças e adolescentes quanto às suas características e fatores de risco. FONTES DE DADOS: A pesquisa de artigos foi realizada nas bases de dados PubMed e SciELO pela combinação dos termos 'crianças', 'adolescentes', 'comportamento alimentar', 'transtorno alimentar', 'bulimia' e 'anorexia', nos idiomas português e inglês. Foram considerados os artigos publicados entre 2007 e 2011, sendo selecionados 49 que analisaram o desenvolvimento do comportamento alimentar e de seus transtornos, a anorexia e a bulimia nervosa e os transtornos alimentares não especificados. SÍNTESE DOS DADOS: Os transtornos alimentares, em especial os não especificados, mostraram-se comuns na infância e na adolescência. Sua presença foi atribuída principalmente ao ambiente familiar e à exposição aos meios de comunicação. As comorbidades psicológicas muitas vezes acompanhavam o diagnóstico do transtorno. CONCLUSÕES: Dentre os fatores de risco para os transtornos alimentares, destacaram-se a mídia e os ambientes social e familiar. A influência da mídia e do ambiente social foi associada, principalmente, ao culto à magreza. Já no âmbito familiar, o momento das refeições mostrou-se fundamental na determinação do comportamento alimentar e no desenvolvimento de seus transtornos. Os transtornos alimentares se associaram a problemas nutricionais (déficit no crescimento e ganho de peso), à saúde bucal (queilose, erosão dental, periodontites e hipertrofia das glândulas salivares) e aos prejuízos sociais.

OBJECTIVE: To discuss eating disorders in children and adolescents regarding their characteristics and risk factors. DATA SOURCES: Articles were searched in the PubMed and ScieLO databases, combining the terms 'children', 'adolescents', 'eating behavior', 'eating disorder', 'bulimia', and 'anorexia', both in Portuguese and in English. Studies published between 2007 and 2011 were retrieved and 49 articles that assessed eating behavior and disorders, nervous anorexia and bulimia, and non-specific eating disorders were selected. DATA SYNTHESIS: Eating disorders, especially non-specific ones, were common during childhood and adolescence. The presence of such disorders was attributed mainly to family environment and exposure to the media. Eating disorders were frequently followed by psychological comorbidities. CONCLUSIONS: Among the risk factors for eating disorders, social and family environment and the media were the most important ones. The influence of the media and social environment has been related to the worship of thinness. As to family environment, mealtimes appeared to be fundamental in shaping eating behavior and the development of disorders. Eating disorders were associated with nutritional problems (growing impairment and weight gain), oral health (cheilitis, dental erosion, periodontitis, and hypertrophy of salivary glands), and social prejudice.

OBJETIVO: Discutir los trastornos alimentares en niños y adolescentes respecto a sus características y factores de riesgo. FUENTES DE DATOS: La investigación de artículos se realizó en las bases de datos PubMed y SciELO por la combinación de los términos "niños", "adolescentes", "comportamiento alimentar", "trastorno alimentar", "bulimia" y "anorexia", en los idiomas portugués e inglés. Se consideraron los artículos publicados entre 2007 y 2011, siendo seleccionados 49 que analizaron el desarrollo del comportamiento alimentar y de sus trastornos, la anorexia y la bulimia nerviosa y los trastornos alimentares no especificados. SÍNTESIS DE LOS DATOS: Los trastornos alimentares, en especial los no especificados, se mostraron comunes en la infancia y en la adolescencia. Su presencia fue asignada principalmente al ambiente familiar y a la exposición a los medios de comunicación. Las comorbilidades psicológicas muchas veces acompañan el diagnóstico del trastorno. CONCLUSIONES: Entre los factores de riesgo para los trastornos alimentares, se destacan los medios y los ambientes social y familiar. La influencia de los medios y del ambiente social fue asociada, principalmente, al culto a la delgadez. En el ámbito familiar, a su vez, el momento de la comida se mostró fundamental en la determinación del comportamiento alimentar y en el desarrollo de sus trastornos. Los trastornos alimentares se asociaron a problemas nutricionales (déficit en el crecimiento y ganancia de peso), a la salud oral (queilosis, erosión dental, periodontitis e hipertrofia de las glándulas salivares) y a los perjuicios sociales.

Prevalence and clinical impact of eating disorders in bipolar patients / Prevalência e impacto clínico dos transtornos alimentares sobre os pacientes bipolares

OBJECTIVES: To study the impact of eating disorders (EDs) on the severity of bipolar disorder (BD). METHODS: The Structured Clinical Interview for DSM-IV Axis I (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D-17), Hamilton Anxiety Rating Scale (HAM-A), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were used. Clinical and sociodemographic data were also collected. RESULTS: Among the 356 bipolar patients included in this study, 19 (5.3 percent) were also diagnosed with ED. Of these, 57.9 percent had bulimia nervosa (BN) and 42.1 percent had anorexia nervosa (AN). Among ED patients, 94.7 percent were female. Bipolar patients with EDs presented with lower scores in the mental health domain of the WHOQOL-BREF, higher scores of depressive symptoms, and more psychiatric comorbidities. CONCLUSIONS: ED comorbidities imposed important negative outcomes in bipolar patients. This finding suggests that attention should be given to the presence of EDs in BD patients and that better treatments focused on this population should be developed.

OBJETIVO: Estudar a influência dos transtornos alimentares (TA) na gravidade do transtorno bipolar (TB). MÉTODOS: Foram utilizadas a Entrevista Clínica Estruturada para o Eixo I do DSM-IV (SCID-I), a Escala de Young para Avaliação da Mania (YMRS), a Escala de Hamilton para Avaliação da Depressão (HAM-D-17), a Escala de Hamilton para Avaliação da Ansiedade (HAM-A), a Avaliação do Funcionamento Global (GAF) e a Escala Breve de Avaliação da Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-BREF). Os dados clínicos e sociodemográficos também foram coletados. RESULTADOS: Entre os 355 pacientes com TB incluídos neste estudo, 19 (5,3 por cento) também foram diagnosticados como portadores de TA. Destes, 57,9 por cento tinham bulimia nervosa (BN) e 42,1 por cento anorexia nervosa (AN). Dentre os pacientes com TA, 94,7 por cento eram do gênero feminino. Os pacientes portadores de TB e TA apresentaram escores mais baixos do domínio saúde mental da WHOQOL-BREF, escores mais elevados de sintomas depressivos e mais comorbidades psiquiátricas. CONCLUSÕES: A presença de comorbidades com TA acarreta importantes desfechos negativos em pacientes bipolares. Este achado sugere que atenção deva ser dada à presença de TA em pacientes com TB e que melhores tratamentos focados nessa população sejam desenvolvidos.

Características psicológicas de mães de pacientes com anorexia nervosa: implicações para o tratamento e prognóstico / Psychological characteristics of mothers of patients with anorexia nervosa: implications for treatment and prognosis

INTRODUCTION: The complexity of factors involved in anorexia nervosa (AN) and the recommendations of prominent health organizations underscore the importance of reflecting on therapeutic interventions aimed at patients' family members. OBJECTIVE: To expand knowledge about the mother-daughter relationship in AN, with a focus on developing a conceptual framework that is able to improve the treatment of the disorder, reduce factors that perpetuate it and improve prognosis. METHOD: A clinical method, anchored by psychodynamic references, was employed in a group of family members of patients with eating disorders. The group met weekly, and sessions were led by psychologists from the eating disorder outpatient clinic of a university hospital. RESULTS AND DISCUSSION: Common characteristics in the mother-daughter relationship in cases of AN were identified. The issue of mutual control, the dialectic between omnipotence and impotence, and the relationship of devotion, passion and annihilation between mothers and daughters are phenomena that form the basis of AN, with a direct influence on the severity of each case and on treatment success. CONCLUSION: Our findings allowed us to identify important aspects in the mother-daughter relationship in AN, which may improve the clinical interventions aimed at treating the disorder.

INTRODUÇÃO: A complexidade de fatores que compõem a anorexia nervosa (AN) e as recomendações de importantes organizações ligadas à saúde torna fundamental uma reflexão acerca de propostas de intervenções psicoterapêuticas direcionadas aos familiares desses pacientes. OBJETIVO: Expandir o conhecimento acerca da relação mãe-filha na AN, visando desenvolver uma estrutura conceitual que aperfeiçoe o tratamento do transtorno, reduza os fatores que o mantêm e melhore o prognóstico. MÉTODO: Utilizou-se um método clínico de observação fundamentado em referenciais psicodinâmicos de um grupo de familiares de pacientes com transtornos alimentares. O grupo aberto, semanal, era coordenado por psicólogas do ambulatório de transtornos alimentares de um hospital universitário. RESULTADOS E DISCUSSÃO: Foram identificadas características comuns da relação mãe-filha nos casos de AN. A questão do controle mútuo, a dialética entre onipotência e impotência e a relação de devoção, paixão e aniquilamento entre mães e filhas são fenômenos que estão na base da estrutura da AN, com influência direta sobre a gravidade de cada caso e sobre o sucesso das possibilidades terapêuticas. CONCLUSÃO: Os achados possibilitaram identificar importantes aspectos da relação mãe-filha na AN, que podem aprimorar as intervenções clínicas para seu tratamento.

A anorexia nervosa e fatores associados em adolescentes do sexo feminino, em município do sul do Brasil / In anorexia nervosa and associated factors in female adolescents city in south of Brazil

Objetivo foi investigar a prevalência de sintomas de anorexia nervosa e a sua associação com o Índice de Massa Corporal (IMC), e com satisfação e dimensão corporais, em adolescentes do sexo feminino. Trata-se de um estudo de base populacional, do tipo transversal, realizado com 407 adolescentes entre 14 e 19 anos, e incluiu a avaliação do IMC, o Eating Attitude Test, e a Escala de Silhuetas Corporais. A associação entre as variáveis dependente e independente foi realizada por meio da análise univariada, seguida da multivariada com ajuste do modelo logístico. A prevalência dos sintomas de anorexia foi de 15,97%, sendo que as adolescentes insatisfeitas com a sua imagem corporal têm 2,56 (IC 1,11-5,83) mais chances de desenvolver sintomas de anorexia. A maioria delas apresentou-se eutrófica (83,78%), e não foi observada relação entre o IMC e presença de sintoma de anorexia. Os resultados sugerem que a insatisfação corporal está relacionada à presença do sintoma de anorexia, indicando a necessidade de uma atuação multidisciplinar junto à população estudada.

The objective was to identify the prevalence of anorexia nervosa symptoms and its associations with body mass index (BMI) and body size satisfaction among female adolescents. It is a cross-sectional population based study of 407 adolescents aged between 14 and 19, including the BMI assessment, the Eating Attitude Test and the Silhouette Scale. The association between the dependent and independent variables was performed by the univariate analyses and followed by a multivariate analysis with adjusted logistic model. The prevalence of symptoms of anorexia nervosa was 15.97%, and the adolescents who are dissatisfied with their body image have 2.56 (IC 1,11-5,83) times increased risk of developing symptoms of anorexia. Most of them are eutrophic (83.78%), and there was no connection between the presence of symptoms of anorexia and the BMI. The results suggest that body dissatisfaction is related to the symptoms of anorexia, which indicates the need of a multidisciplinary performance with the population.

Anorexia nervosa e retardo mental / Anorexia nervosa and mental retardation

OBJETIVO: Revisar a literatura pertinente, observando a prevalência, etiopatogenia, aspectos nutricionais, diagnóstico e tratamento da anorexia nervosa (AN) em pacientes com retardo mental (RM). MÉTODO: Revisão bibliográfica realizada nos sistemas Medline, SciELO e PubMed usando os descritores "transtornos alimentares", "anorexia nervosa" e "retardo mental". RESULTADOS: A AN pode se manifestar de formas atípicas em indivíduos com RM, exigindo critérios diagnósticos específicos. O mais utilizado atualmente é o Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation, conhecido por DC-LC. A prevalência é incerta e o tratamento ainda não está estabelecido, apesar de exigir treinamento específico da equipe. A alimentação costuma ser "pobre" e alimentos que engordam normalmente são evitados. Na maioria das vezes, é difícil acessar a complexa psicopatologia da AN nesses pacientes, em virtude das dificuldades de obter o relato de insatisfação e/ou distorção da imagem corporal, baixa autoestima e crenças alimentares. CONCLUSÃO: Muitos fatores indicam a necessidade de maiores estudos de AN no RM, entre eles a falta de critérios diagnósticos próprios validados e diretrizes para tratamento. Paralelamente, o debate da forma de acesso à conceitualização e ao tratamento dos distúrbios da imagem corporal nessa população deve ser intensificado.

OBJECTIVE: To review prevalence, ethiopathogenesis, nutritional aspects, diagnostic and treatment in patients with MR and anorexia nervosa (AN). METHOD: A literature review was carried out in Medline, SciELO and PubMed using the key words "eating disorders", "anorexia nervosa" and "mental retardation". RESULTS: Anorexia nervosa may have an atypical presentation in patients with MR, and therefore requires specific diagnostic criteria. It is currently used the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LC). There are no recommendations on treatment either but the care team requires specific training. Eating is usually "poor" and fattening foods are often avoided. It is most often difficult to access the complex psychopathology of AN in these patients due to difficulty obtaining an account of dissatisfaction and/or distorted body image, low self-esteem, and food beliefs. CONCLUSION: There is a need for further studies investigating AN in patients with RM, especially because there are no validated diagnostic criteria and guidelines for treatment. In addition, the discussion on how to approach these patients as well as on the conceptualization and treatment of body image disorders in this population should be stimulated.

Wilkie's syndrome

Wilkie's syndrome is a rare variant of small intestinal obstruction resulting from compression of third part of the duodenum by the superior mesenteric artery. A girl 15 years of age, presented with postprandial abdominal pain, bilious vomiting and weight loss. Radiological imaging revealed vascular duodenal compression which was relieved by timely surgical intervention

Experiências e Expectativas em Práticas de Atividades Físicas de Pessoas com Anorexia Nervosa / Experiencias y Expectativas en Prácticas de Actividades Físicas de Personas con Anorexia Nerviosa / Experiences and Expectations in Practice in Physical Activities of People with Anorexia Nervosa

Através de um estudo exploratório descritivo de cunho qualitativo, foram investigadas as experiências motoras em pessoas com anorexia nervosa, explorando seus motivos, suas expectativas, sua relação com o exercício no curso do transtorno e o papel do professor de educação física. Os dados reforçam a necessidade de proporcionar um ambiente seguro, de respeito às individualidades e auxílio no reconhecimento dos limites e das sensações corporais em propostas de atividades físicas para pessoas com anorexia nervosa.

Through a descriptive exploratory study, in a qualitative perspective, body experiences and physical activities were investigated in people with anorexia nervosa, exploiting their motives, their expectations, their relationship with the exercise in the course of the disorder and the role of teacher of physical education. The data reinforce the need to provide a safe environment, respect with the individualities and aid in the recognition of the limits and bodily sensations in proposals for physical activities for people with Anorexia Nervosa.

Através de un estudio exploratorio descriptivo de cuño cualitativo, fueron investigadas las experiencias motoras en personas con anorexia nerviosa, explorando sus motivos, sus expectativas, su relación con el ejercicio en desarrollo de trastorno y el rol del profesor de educación física. Los datos refuerzan la necesidad de proporcionar un ambiente seguro, de respeto a la individualidad y auxilio en el reconocimiento de límites y sensaciones corporales en propuestas de actividades físicas para personas con Anorexia Nerviosa.

[Assessment of body image and its relationship with eating disorders among female students of Islamic Azad University, Tehran center branch]

One of the prevalent psychological disorders, mainly occurring at the end of adolescence and early young hood, is eating disorder which is characterized by abnormal pattern of eating and miscognition of body weight and food consumption. The aim of this study was to determine the body image and its relation with the eating disorder among female students of Islamic Azad University in Tehran center branch. In this descriptive-correlative study, EAT [eating attitudes test] and MBSRQ [multidimensional body self relations questionnaire] were administered to 400 female students selected randomly by stratified sampling. Data were analyzed by chi-square and exact Fisher test using SPSS ver.14 software. Majority of students [87%] had negative body image. According to eating attitudes test [EAT], 21.5% of students had eating disorder. Eating disorder diagnostic inventory [EDDI] revealed that 1.8% and 7.8% of students had anorexia nervosa [AN] and bulimia nervosa [BN], respectively. There was significant correlation between eating disorders and body mass index [p<0.05] and father job [p=0.05]. The prevalence of eating disorder among Iranian female students is almost similar to other countries. The majority of people with negative body image had eating disorder, however there was no significant correlation between body image and eating disorders

Prevalência de sintomas de anorexia nervosa e insatisfação com a imagem corporal em adolescentes do sexo feminino do Município de Florianópolis, Santa Catarina, Brasil / Prevalence of symptoms of anorexia nervosa and dissatisfaction with body image among female adolescents in Florianópolis, Santa Catarina State, Brazil

Objetivou-se identificar a prevalência de sintomas de anorexia nervosa e de insatisfação com a imagem corporal em adolescentes (sexo feminino) de Florianópolis, Santa Catarina, Brasil. A amostra foi proporcional, estratificada conforme rede escolar (pública/privada) e região sócio-geográfica, posteriormente distribuída no ensino fundamental e médio. Foram analisadas 1.148 adolescentes sorteadas aleatoriamente nos estratos. A presença de sintomas de anorexia nervosa (EAT+) foi identificada pelo Teste de Atitudes Alimentares e a avaliação da imagem corporal pelo Questionário de Imagem Corporal. As prevalências de EAT+ e insatisfação com a imagem corporal foram 15,6 por cento e 18,8 por cento. O EAT+ apresentou-se associado à faixa de 10-13 anos (OR = 1,542; p = 0,046); sobrepeso e obesidade (OR = 2,075; p < 0,001); insatisfação com a imagem corporal (OR = 14,392; p < 0,0001) e rede pública (OR = 1,423; p = 0,041). A regressão logística múltipla apontou a insatisfação com a imagem corporal como a variável independente de maior risco para a manifestação dos sintomas (OR = 16,7; p < 0,001). Pode-se concluir que as adolescentes em Florianópolis apresentam índices de EAT+ semelhantes àqueles observados em outras regiões brasileiras.

The objective of this study was to identify the prevalence of symptoms of anorexia nervosa (EAT+) and dissatisfaction with body image among female adolescents in Florianópolis, Santa Catarina State, Brazil. The proportional sample (1,148 adolescents) was stratified according to position of schools in the socio-geographic regions and public/private school classification, and was subsequently distributed according to primary and secondary schools. EAT+ was identified through the Eating Attitudes Test and evaluation of body image through the Body Shape Questionnaire. Prevalence rates for EAT+ and dissatisfaction with body image were 15.6 percent and 18.8 percent, respectively. EAT+ was associated with age (10-13y) (OR = 1.542; p = 0.046); overweight/obesity (OR = 2.075; p < 0.001); dissatisfaction with body image (OR = 14.392; p < 0.001); and public schools (OR = 1.423; p = 0.041). Multiple logistic regression showed dissatisfaction with body image as the strongest independent risk factor for symptoms of anorexia nervosa (OR = 16.7; p < 0.001). Adolescents in Florianópolis show EAT+ rates similar to those observed in other regions of Brazil.

Comportamento anoréxico e percepção corporal em universitários / Anorexic behavior and body self-perception on universitarians

OBJETIVO: Avaliar a percepção corporal e a prevalência de sintomas de anorexia nervosa em estudantes universitários. MÉTODOS: Estudo transversal, no qual a seleção da amostra foi realizada por conveniência. Aplicou-se o questionário teste de atitudes alimentares (EAT- 26) e teste de imagem corporal, para avaliar os sintomas de anorexia nervosa e a percepção corporal, respectivamente. Para a análise estatística dos dados utilizou-se o teste binomial para verificar a existência de associação entre as variáveis qualitativas. RESULTADOS: Participaram do estudo 149 estudantes de nutrição e 78 estudantes de educação física. Observou-se que 10,3 por cento e 14,1 por cento dos estudantes de educação física e nutrição, respectivamente, apresentaram fatores de risco para desenvolver anorexia nervosa e o teste de imagem corporal evidenciou proporções elevadas de insatisfação com a forma corporal, em ambos os cursos: 75,8 por cento e 78,2 por cento para os cursos de nutrição e educação física, respectivamente. CONCLUSÃO: Os estudantes de nutrição mostraram maior tendência de apresentar comportamento de risco para anorexia nervosa, com predominância no sexo feminino. Além disso, os resultados evidenciaram proporções elevadas de insatisfação com a imagem corporal, em ambos os cursos. Estes resultados são preocupantes, tendo em vista que são futuros profissionais que possuem papel fundamental na detecção e, no caso do nutricionista, no manejo destes distúrbios.

OBJECTIVE: To assess body perception and prevalence of symptoms of nervous anorexy in college students. METHODS: Cross-sectional study with convenience sample. We used the Eating Attitudes Test questionnaire (EAT-26) and the Body Image Test to evaluate symptoms of nervous anorexy and the body perception on the participants, respectively. In the statistical analysis, Binomial test was used to assess the association between qualitative variables. RESULTS: This study included 149 nutrition and 78 physical education students. The results showed that 10.3 percent and 14.1 percent of the physical education and nutrition students, respectively, presented risk factors for the development of anorexy, and the Body Image Test revealed high levels of dissatisfaction regarding body shape of students in both courses: 75.8 percent and 78.2 percent in nutrition and physical education, respectively. CONCLUSION: Students of nutrition showed greater tendency to present risk behavior for developing nervous anorexy, predominantly in females. Moreover, the results showed high proportions of dissatisfaction with body image in both courses. These results raise concern, since the physical education teachers and nutritionists are the professionals who play a key role in detecting and, in the case of a nutritionist, managing these disorders.

Trastorno depresivo, ansiedad social y su prevalencia en trastornos de la conducta alimentaria / Depressive disorder, social anxiety and its prevalence in eating disorders

Background: There is substantial evidence about comorbidity between eating disorders, depression and social anxiety. Aim: To compare the presence of social anxiety and depression and its prevalence in eating disordered patients and normal subjects. Subjects and Methods: A structured clinical interview, the Eating Attitudes Test (EAT-40), the Eating Disorder Inventory (EDI), the Liebowitz Social Anxiety Scale (LSAS) and the Hamilton Depression Rating Scale (HDRS) were administered to 54 patients that fulfilled the DSM-IV diagnostic criteria for eating disorders and to 54 normal female students. Results: Patients with eating disorders ranked significantly higher on the EAT-40 and on the EDI and its factors, including comorbidity scales (p < 0.001). Prevalence of social anxiety was significantly higher in eating disordered patients (40. 7 percent versus 3.7 percent) (p < 0.001), particularly among anorexics (66.6 percent) (p < 0,001) and 14.8 percent of the eating disordered patients ranked within the severe range (p < 0.001). Theriskfor moderate to very severe social anxiety was 5.5 times higher among them. Prevalence of depressive symptoms was significantly higher in eating disordered patients (7& 5 percent versus 0 percent) (p < 0.001), specially among anorexics (66.6 percent) (p < 0,001) and 18.5 percent of the eating disordered patients ranked within the severe or very severe range (p < 0.001). The risk for moderate to very severe depression was 23.7 times higher among them. Conclusions: Depressive and/or social anxiety disorders and their prevalence rates are confirmed according to the evidence in eating disordered patients, mainly among patients suffering from anorexia nervosa.

Antecedentes: Existe considerable evidencia sobre la comorbilidad entre trastornos de la conducta alimentaria, depresión y fobia social. Objetivo: Comparar la presencia de ansiedad social y depresión y sus prevalencias, en mujeres con y sin patologías alimentarias. Sujetos y Métodos: Se administró una entrevista clínica estructurada, el Test de Actitudes Alimentarias (EAT-40), el Inventario de Desórdenes Alimentarios (EDI), la Escala de Ansiedad Social de Liebowitz (LSAS) y la Escala de Hamilton para Depresión (HDRS) a 54 pacientes que satisficieron los criterios diagnósticos según el DSM-IVpara trastornos de la conducta alimentaria y a 54 estudiantes sin problemas alimentarios. Resultados: Los puntajes de todos los indicadores, incluidas las escalas de comorbilidad, fueron mßs altos en las pacientes (p < 0,001). La prevalencia de ansiedad social fue significativamente mayor en las pacientes alimentarias (40,7 por ciento versus 3,7 por ciento) (p < 0,001), particularmente en las anorécticas (66,6 por ciento) (p < 0,001) y el 14,8 por ciento de las pacientes con patologías alimentarias obtuvo puntajes en los rangos severo o muy severo (p < 0,001). El riesgo de presentar ansiedad social moderada a muy severa en las pacientes alimentarias fue 5,5 veces mayor. La prevalencia de síntomas depresivos fue significativamente mayor en las pacientes alimentarias (18,5 por ciento versus 0 por ciento) (p < 0,001), especialmente en las anorécticas (66,6 por ciento) (p < 0,001) y 18,5 por ciento de las pacientes con trastornos alimentarios obtuvo puntajes en el rango severo (p < 0,001). El riesgo de presentar depresión moderada a muy severa en las pacientes alimentarias fue 23,7 veces mayor. Conclusiones: Se confirma la presencia y la prevalencia de trastornos depresivos y de ansiedad social en los desórdenes alimentarios según la evidencia, principalmente en las pacientes portadoras de anorexia nerviosa.

Programa de transtornos de alimentación en adolescentes y jóvenes chilenos: variaciones a seis meses de tratamiento / Multidisciplinary treatment of eating disorders in Chilean adolescents and young adults: Six months outcome

Background: Eating disorders may have serious organic consequences derived from under nutrition, specific nutrient deficiencies and electrolytic disturbances and reach a mortality as high as 12 percent. Aim: To describe the features and outcome after six months of treatment of patients attending the Eating Disorders Unit at the Catholic University Hospital in Chile. Material and methods: Review of medical records of patients with eating disorders that received a multidisciplinary treatment by a team of nutritionists, psychiatrists and psychologists and were seen at least twice in a period of six months. Results: The records of 81 patients (mean age 16.3±3 years, only one male) were included in the review. Forty nine patients had Anorexia Nervosa of the restricting type, five of the purging type, 22 had Bulimia Nervosa of the purging type and two of the non purging type and three patients had an eating disorder not otherwise specified. Eighty percent consulted within the first year of symptom appearance. Sixty five percent came from families with both parents living together, 57 percent had a rigid and agglutinated family structure and 65 percent had occult crises. Depression or dysthymia was found in 45 percent of patients and drug therapy was required at the beginning of treatment in 25 percent. Obsessive traits (40.4 percent) were significantly related to restrictive eaters. A past history of obesity or overweight was common. After six months of treatment, body mass index increasing significantly in restrictive eaters with obsessive traits and occult family crises was noticed. Conclusions: A multidisciplinary therapeutic intervention improved body mass index and family symptoms in patients with restrictive eating disorders.